Empowering elderly care with intelligent IoT-Driven smart toilets for home-based infectious health monitoring

The COVID-19 pandemic highlights the need for effective and non-intrusive methods to monitor the well-being of elderly individuals in their homes, especially for early detection of potential viral infections. Conspicuously, the present paper develops a Multi-scaled Long Short Term Memory (Ms-LSTM) model for the routine health monitoring of elderly patients to detect COVID-19. The proposed method offers home-based health diagnostics through urine analysis by leveraging the IoT-Fog-Cloud paradigm. Mainly, the proposed model constitutes a four-layered architecture: data acquisition, fog layer, cloud layer, and interface layer. Each layer serves distinct functionalities and provides specific services, thereby collectively enhancing the overall effectiveness of the model. The statistical results of the study demonstrate the superior performance of the proposed Ms-LSTM model in comparison to state-of-the-art methods, including Artificial Neural Networks (ANN), K-Nearest Neighbors (K-NN), Support Vector Machine (SVM), Random Forest, and LSTM. Further, the proposed model attains a mean temporal efficiency of 39.23 seconds. It exhibits high reliability (92.97%), stability (70.06%), and predictive accuracy (93.25%).

A worm in the toilet bowl! What does it tell us about the challenges in the identification of supposed human parasites in practical parasitology?

Non-parasitic vermiform organisms can circumstantially be associated with humans and their identification can be challenging for medical professionals. The present report describes the finding of a worm in the toilet bowl by a patient from Brazil, who thought he had expelled it in his feces. The gross analyses in a clinical laboratory reveal the worm was different from other macroscopic organisms routinely identified, and the laboratory staff requested assistance in an academic laboratory specialized in helminthology. After preliminary analysis in a stereomicroscope, the supposed human worm was identified as an oligochaete annelid (earthworm). The patient was contacted to investigate a possible case of pseudoparasitism. However, we were informed that the organism had been collected in a toilet bowl from a rural environment where the untreated water comes from a cistern indicating our finding was circumstantial. The methodology revisited herein allowed a quick microscopic analysis of easy-to-view morphological structures, which are useful to separate oligochaete annelids from helminths and can prevent misdiagnosis in similar situations. We discuss the overly restricted view on human parasites by health professionals in collecting clinical history and laboratory analysis, providing some epistemological insights on the necessary interdisciplinarity between parasitology and other basic knowledge with health practice.

Circadian Rhythm of Voided Volume, Maximum Flow Rate, and Voiding Time Evaluated by Toilet Uroflowmetry in Hospitalized Women With Nocturia

OBJECTIVE

To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change.

METHODS

We evaluated 2602 urinations of 58 female patients (age, 68.4 ± 15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years.

RESULTS

VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6 ± 11.7 ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8 ± 0.93 ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction = .0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old.

CONCLUSION

The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.

Partial nitritation and nitrogen removal of vacuum toilet wastewater from high-speed trains in a sequential batch reactor

Owing to the high contents of organics and nitrogen in vacuum toilet wastewater (VTW) generated from high-speed trains, onsite pretreatment is usually required before VTW can be discharged into municipal sewers. In this study, a partial nitritation process was stably established in a sequential batch reactor to efficiently utilize the organics in synthetic and real VTWs for nitrogen removal and to produce an effluent suitable for anaerobic ammonia oxidation. In spite of the high fluctuations of COD and nitrogen in VTW, the organics used for nitrogen removal stabilized at 1.97 ± 0.18 mg COD mg N^-1 removed, and the effluent NO₂^--N/NH₄⁺-N ratios were maintained at 1.26 ± 0.13. The removal efficiencies of nitrogen and COD were 31.8 ± 3.5% and 65.2 ± 5.3% under the volumetric loading rates of 1.14 ± 0.15 kg N m^-3 d^-1 and 1.03 ± 0.26 kg COD m^-3 d^-1 for real VTW, respectively. Microbial community analysis revealed that Nitrosomonas (0.95%-1.71%) was the dominant autotrophic ammonium-oxidizing bacterial genus, but nitrite-oxidizing bacteria, Nitrolancea, was severely inhibited, with a relative abundance less than 0.05%. The relative abundance of denitrifying bacteria increased by 7.34% when the influent was switched to real VTW. Functional profile predictions of the biomass showed that the decrease in the COD/N ratio and the switch of reactor influent from synthetic to real VTW increased the relative abundance of enzymes and modules involved in carbon and nitrogen metabolisms.

Removal of toilet paper fibers from residential wastewater: a life cycle assessment

Toilet paper has been reported as one of the major insoluble pollutant components in the influent of wastewater treatment plants. Toilet paper fibers contribute to a large production of sewage sludge, resulting in a high treatment cost and high energy consumption. To find energy-efficient, cost-effective, and environment-friendly technologies for fiber removal and resource recovery from wastewater, a life-cycle assessment (LCA) was performed to analyze the wastewater treatment processes, including a sieving process for removing and recovering suspended solids before the biodegradation units. Based on the LCA results, it was estimated that the sieve screening process saved 8.57% of energy consumption. The construction phase of sieving consumed 1.31% energy cost compared with the operation phase. Environmental impact analysis showed that sieving reduced the impacts of climate change, human toxicity, fossil depletion, and particulate matter formation, which reduced the total normalized environmental impacts by 9.46%. The life-cycle analysis of the removal of toilet paper fibers from wastewater revealed the need to use more efficient methods to enhance the recovery of cellulose fibers.

Flushing Toilets and Cooling Spaces with Seawater Improve Water-Energy Securities and Achieve Carbon Mitigations in Coastal Cities

Exploring alternative water sources and improving the efficiency of energy uses are crucial approaches to strengthening the water-energy securities and achieving carbon mitigations in sub(tropical) coastal cities. Seawater use for toilet flushing and district cooling systems is reportedly practical for achieving multiaspect benefits in Hong Kong. However, the currently followed practices are yet to be systematically evaluated for scale expansions and system adaptation in other coastal cities. The significance of using seawater to enhance local water-energy securities and carbon mitigations in urban areas remains unknown. Herein, we developed a high-resolution scheme to quantify the effects of the large-scale urban use of seawater on a city's reliance on non-local and non-natural water and energy supplies and its carbon mitigation goals. We applied the developed scheme in Hong Kong, Jeddah, and Miami to assess diverse climates and urban characteristics. The annual water and energy saving potentials were found to be 16-28% and 3-11% of the annual freshwater and electricity consumption, respectively. Life cycle carbon mitigations were accomplished in the compact cities of Hong Kong and Miami (2.3 and 4.6% of the cities' mitigation goals, respectively) but not in a sprawled city like Jeddah. Moreover, our results suggest that district-level decisions could result in optimal outcomes supporting seawater use in urban areas.

Comparing Two Methods of Reducing Hospital Toilet Aerosols

BACKGROUND

When flushed, uncovered hospital toilets have been shown to generate aerosols potentially containing bacteria, viruses, and hazardous drugs, which can be inhaled by healthcare workers and contaminate surfaces. Guidelines recommend placing a plastic-backed absorbent pad (PBP) over the toilet, although no studies have evaluated the effectiveness of this intervention.

OBJECTIVES

The purpose of this study was to evaluate the effectiveness of using a PBP versus the Splashblocker®, a solid, reusable engineering barrier control, to reduce post-flush aerosol particles.

METHODS

Aerosol measurements were taken with an optical particle counter in a bathroom testing chamber equipped with a commercial hospital toilet and flushometer valve. Three tests were performed at a height of 16 inches above the floor and 40 inches above the floor.

FINDINGS

Both the PBP and the Splashblocker significantly reduced the number of post-flush particles by more than 99% at 16 inches above the floor and 40 inches above the floor. The results indicate that both interventions are equally beneficial in reducing aerosols after flushing a hospital toilet.

Spread of flushing-generated fecal aerosols in a squat toilet cubicle: Implication for infection risk

Toilet flushing generates and spread fecal aerosols, potentially leading to infection transmission risk. Squat toilets are widely used in public restrooms in some Asian countries including China and India, and remain to be studied. Aerosol dispersion while flushing squat toilet in cubicle was visualized, while the aerosol concentrations were measured on different surfaces by monitoring fluorescence intensity through seeding simulated fluorescence feces. Flushing-generated fecal aerosols could spread to the breathing zone, deposit on floor, and partitions in squat toilet cubicles, and spread even beyond to the restroom lobby. A total of 0.24 % and 0.17 % of seeded fecal waste deposits on the floor and partition (lower than 0.20 m) for each flush. Aerosol concentration decays rapidly, with 86.8 ± 2.2 % reduction in the second minute after a previous flush compared to that in the first minute. Public toilet users are recommended to wait for 2 min after the early flush before entering the cubicle.

Sensor-based evaluation of a Urine Trap toilet in a shared bathroom

Urine diversion in a No-Mix Toilet is a promising approach for sustainable fertilizers and reduction of the nutrient load for wastewater treatment; however, user adoption remains a challenge. This study evaluates the Urine Trap, a passive No-Mix toilet design based on the teapot effect, wherein the urine stream inlet is invisible to the user and therefore it does not impact the user experience for increased adoption. This study evaluated the nutrient separation performance of a Urine Trap flush toilet in a bathroom shared by women in two sites in India. Over three different testing periods, 841 uses of this squat plate were recorded in 50 days. Analytical measurements found 36 % separation efficiency for total nitrogen (TN). While effective, the Urine Trap under test by users did not yield a 70-80 % TN separation efficiency observed under engineering characterization. High temporal resolution data from sensors on waste collection tanks, the opening of the bathroom door, and cleansing water flow were used to gain insights into hygiene practices. The data showed a frequent habit of wetting the squat plate during physiological excretion, a hygienic practice that eases cleaning but degrades the teapot separation effect of the Urine Trap design. By using sensors, we demonstrate a method to non-invasively gain quantitative insights into hygiene practices to inform sanitation technologies deployment strategies for improved outcomes.

Humans peeing: Justice-involved women's access to toilets in public spaces

Justice-involved women face myriad challenges as they negotiate the terms of community supervision and manage the long-term implications and stigma of living with a criminal record. Major tasks that women juggle include securing safe, affordable housing, finding and retaining employment, accessing physical and mental health care (including substance use treatment), and handling relationships with family, friends, children, and intimate partners. In addition to these responsibilities, women must meet their basic physiological needs to eat, sleep, and use the toilet. Women's ability to safely meet their personal care needs may impact their capacity to manage their criminal-legal challenges. This study uses qualitative methods to understand justice-involved women's lived experiences related to urination. Specifically, the study reports on a thematic analysis of 8 focus groups conducted with justice-involved women (n = 58) and the results of a toilet audit conducted in the downtown areas of the small city in the United States where the focus group participants were living. Findings suggest that women had limited access to restrooms and reported urinating outside. Lack of restroom access impacted their engagement with social services support and employment and their ability to travel through public spaces. Women perceived their public toilet options as unsafe, increasing their sense of vulnerability and reinforcing the idea that they did not have full access to citizenship in the community because of their criminal-legal involvement. The exclusion and denial of women's humanity that is perpetuated by a lack of public toilet access impacts women's psychosocial outcomes. City governments, social service agencies, and employers are encouraged to consider how lack of toilet access may impact their public safety and criminal-legal objectives and expand opportunities for people to access safe restroom facilities.

Performance exploration and microbial dynamics of urine diverting composting toilets in rural China

The ongoing "toilet revolution" in China provides new opportunities to improve the rural living environment and sanitation, and the introduction of new sanitation facilities such as urine diverting composting toilets (UDCTs) is conducive to the effective treatment and resource utilization of feces. This study revealed the degradation performance and microbial community dynamics of UDCTs and clarified the influence mechanism of fecal volume in aerobic composting treatment. The results showed that UDCTs could effectively decompose human feces, with an organic matter degradation rate of 25%⁓30%. The temperature, water content, NH₄⁺-N and nutrient accumulation were higher in the high fecal volume treatment than in the low fecal volume treatment. Bacterial community composition and structure in UDCTs varied with composting stage and fecal volume. The diversity and richness of bacterial community in compost were changed with different fecal volumes, but the dominant groups were similar. Redundancy analysis (RDA) showed that nitrogen and organic carbon were the main drivers of bacterial community changes during composting. Highly nutritious and non-phytotoxic compost products were suitable for agronomic uses. Based on these results, UDCTs can be an effective way to solve the problem of fecal pollution in rural areas, and fecal dosage is a potential influencing factor in the operation and maintenance of composting systems.

Female-friendly toilets in schools in Burkina Faso: A mixed-methods study using photo-elicitation

Background

An absence of gender-sensitive sanitation facilities in schools and the negative effects this has on girls has been widely discussed among advocacy groups, though less examined in academic spheres. Drawing on triangulated data, we outline current challenges and respondent-driven solutions to enhance the female-friendly nature of toilets in a context of extreme poverty.

Methods

This mixed-methods study was informed by the tenets of human-centred design. We first quantitatively assessed facilities in 14 secondary schools in the Kossi Province of Burkina Faso. We then collected qualitative data, including 15 focus group discussions and 53 in-depth interviews among schoolgirls, mothers, teachers and key informants. We applied photo-elicitation, a novel method, to explore perceptions of facilities and the desirability and feasibility of interventions to improve gender-friendly sanitation facilities.

Results

No school met international water, sanitation and hygiene (WASH) standards for schools. Roughly one third of schools did not have water and, when present, there was no reliable way to use it within the toilet complex. Schoolgirls shared feelings of shame and stress when menstruating at school, and said that they would avoid using school toilets, if possible. Schoolgirls described water access as the most urgent need to address, followed by fostering privacy and facilitating cleanliness within facilities. Mothers and teachers mostly aligned with these priorities, while key informants additionally emphasised the need to raise awareness on both general and menstrual hygiene and to develop maintenance systems. Photo-elicitation engaged and empowered participants to pinpoint priorities and concrete solutions, namely a need for doors and locks, water containers and cleaning materials.

Conclusions

WASH needs in many schools remain unmet. Women and girls should be involved in decision-making across stages of intervention design and implementation. Young women's voices merit greater inclusion in academic literature. Future interventions should enhance access to water and privacy. Future research could explore maintenance and monitoring strategies to develop guidance on sustainable solutions.

Accessibility Improvement of Public Schools Through User Involvement in JAPAN

According to the amendment (2020) of the Act on the Promotion of Smooth Transportation, etc. of Elderly Persons, Disabled Persons, etc. in Japan, public primary and junior high schools, which are newly built/renovated/extended, should be designed to be physically accessible for students with special needs. In addition, existing schools should also make efforts to improve accessibility. On this background, this paper focuses on the methods to effectively promote accessibility in schools that is achieved through user involvement for inclusive education. The survey subjects were all 164 public schools in Saitama city. A questionnaire to all schools was conducted to find out 1) the features of physical obstacles impeding inclusive education and 2) examples of user involvement in the planning stage of accessibility. In the results, accessible toilets have been installed progressively. However, inaccessible routes and spaces remained because there were no lifts in most existing schools. Regarding user involvement, a good practice was discovered in one case of restroom renovation which reflected parents' requests. In reality, because of the limitation of the budget of the municipality, it was obviously difficult to provide sufficient accessibility in all 164 schools in the short period. To achieve fully accessible schools for everyone, it is crucial to create short/mid/long-term facility management strategies and to share knowledge/skills regarding accessibility improvement among administrative officers, architects, and users, so that they can find efficient and effective ways to promote accessibility.

Gender-Neutral Toilets: A Qualitative Exploration of Inclusive School Environments for Sexuality and Gender Diverse Youth in Western Australia

School toilets have been identified by sexuality and gender diverse (SGD) students as the least safe spaces in educational institutions. They are sites of verbal, physical and sexual victimisation. Providing gender-neutral toilets in primary and secondary schools may reduce the bullying and victimisation of SGD students, particularly those who are transgender or gender-diverse. This study explored factors influencing the inclusion of gender-neutral toilets in primary and secondary schools in Western Australia. Thirty-four interviews were conducted from May to December 2020 with policy makers or practitioners (n = 22) and school staff (n = 12) in Perth, Western Australia. Interviews were conducted online and face-to-face using semi-structured interview guides. A thematic analysis of the cross-sectional qualitative data was undertaken. School staff, policy makers, and practitioners identified school toilets as sites of bullying and victimisation of SGD youth and expressed support for gender-neutral toilets as an anti-bullying strategy. Perceived barriers to introducing gender-neutral toilets in schools included financial and spatial costs, building code compliance constraints, resistance from parents and students, privacy and confidentiality concerns, and cultural appropriateness. Including gender-neutral toilets in schools may reduce school-based bullying and victimisation, and improve the mental and physical health of SGD youth.

Improving Toilet Usability and Cleanliness in Public Schools in the Philippines Using a Packaged Operation and Maintenance Intervention

This study evaluated the impact of packaged interventions for operation and maintenance (O&M) on the usability and cleanliness of toilets in public schools in the Philippines. In this cluster-randomized controlled trial, the divisions of Roxas City and Passi City were randomly assigned to the intervention or control group. Schools in Roxas City (n = 14) implemented the packaged O&M interventions; schools in Passi City (n = 16) formed the control group. Outcome variables were toilet usability-defined as accessible, functional and private-and toilet cleanliness, measured using the Sanitation Assessment Tool (SAT) and the Cleaner Toilets, Brighter Future (CTBF) instruments at baseline and at four months follow-up through direct observation of school toilets. SAT results showed that intervention schools had a 32.0% (4.6%; 59.3%) higher percentage of usable toilets than control schools at follow-up after full adjustment (p = 0.024). CTBF results found a similar result, although this was not statistically significant (p = 0.119). The percentage of toilets that were fully clean was 27.1% (3.7%; 50.6%) higher in intervention schools than in control schools after adjustment (p = 0.025). SAT results also showed an improvement in cleanliness of toilets in intervention schools compared to those in controls, but this did not remain significant after adjustment. The findings indicate that the additional implementation of O&M interventions can further stimulate progress towards reaching Water, Sanitation and Hygiene service levels aligned with the Sustainable Development Goals.

Strategic complements: Poverty-targeted subsidy programs show additive benefits on household toilet purchases in rural Cambodia when coupled with sanitation marketing

While poverty-targeted subsidies have shown promise as a means of reducing financial constraints on low-income populations to invest in new latrines, concerns have been raised about whether they may reduce demand for new latrines among non-eligible, non-poor populations, especially in geographically limited or closed markets. Using quasi experimental methods, we investigate the interaction effects of the "CHOBA" subsidy, a partial poverty-targeted monetary incentive to build a toilet, and a sanitation marketing program (SanMark) on new latrine uptake among households from different income segments in 110 rural villages across six Cambodian provinces. These programs were implemented either jointly with or independently. Overall, we find strong complementarity of the CHOBA subsidy with SanMark where the coupled implementation of the programs increased latrine uptake across all households as compared to exclusive deployment of the programs independently. Additionally, the CHOBA subsidy alone resulted in higher gains among the poor compared to SanMark suggesting that financial constraint is indeed a significant demand barrier for new latrines. The presence of the poverty-targeted subsidies did not reduce demand for new latrine purchases among ineligible households. Instead, we find some evidence for a positive spillover effect of subsidies on uptake of latrines among ineligible households in villages where both programs were implemented indicating that the presence of sanitation subsidies and the decision to purchase latrines among non-beneficiaries can be viewed as complements. We employ multivariate logistic regressions as well as further robustness checks to estimate the effects of the different interventions, with qualitatively consistent results.

Reducing the particles generated by flushing institutional toilets

Airborne particles play a significant role in the transmission of SARS-CoV-2, the virus that causes COVID-19. A previous study reported that institutional flush-O-meter (FOM) toilets can generate 3-12 times as many droplets as other toilets by splashing (large droplets) and bubble bursting (fine droplets). In this study, an aerosol suppression lid was evaluated to measure the reduction of particles by size using three metrics; number, surface area, and mass concentrations. To quantify toilet flush aerosol over time, detailed particle size distributions (from 0.016-19.81 µm across 152 size bins) were measured from a FOM toilet in a controlled-environment test chamber, without ventilation, with and without use of the suppression lid. Prior to each flushing trial, the toilet bowl water was seeded with 480 mL fluorescein at 10 mg/mL. A high-speed camera was used to record the large droplet movements after flushing. An ultraviolet-visible spectrophotometer was used to analyze the wipe samples to evaluate the contamination on the lid. The particle number, surface area, and mass concentrations without a lid were elevated compared to a lid in the first 90 sec. Overall, the lid reduced 48% of total number concentration, 76% of total surface area concentration, and 66% of total mass concentration, respectively. Depending on the particle size, the number concentration reduction percentage ranged from 48-100% for particles larger than 0.1 µm. Large droplets created by splashing were captured by the high-speed camera. Similar studies can be used for future particle aerodynamic studies. The fluorescein droplets deposited on the lid back sections, which were closer to the FOM accounted for 82% of the total fluorescein. Based on two-way ANOVA analysis, there were significant differences among both the experimental flushes (p = 0.0185) and the sections on the lid (p = 0.0146). Future work should explore the aerosolization produced by flushing and the performance of the lid in real restroom environments, where feces and urine exist in the bowl water and the indoor ventilation system is in operation.

Shared but Clean Household Toilets: What Makes This Possible? Evidence from Ghana and Kenya

Shared sanitation facilities are not considered as basic sanitation owing to cleanliness and accessibility concerns. However, there is mounting evidence that some shared household toilets have a comparable level of service as private toilets. This study examined the factors that contribute to the quality of shared household toilets in low-income urban communities in Ghana and Kenya. The study design comprised household surveys and field inspections. Overall, 843 respondents were interviewed, and 838 household shared sanitation facilities were inspected. Cleanliness scores were computed from the facility inspections, while a total quality score was calculated based on 13 indicators comprising hygiene, privacy, and accessibility. Regression analyses were conducted to determine predictors of cleanliness and the overall quality of the shared sanitation facilities. More than four out of five (84%) shared toilets in Ghana (N = 404) were clean, while in Kenya (N = 434), nearly a third (32%) were clean. Flush/pour-flush toilets were six times (p < 0.01 aOR = 5.64) more likely to be clean. A functional outside door lock on a toilet facility and the presence of live-in landlords led to a threefold increase (p < 0.01 aOR = 2.71) and a twofold increase (p < 0.01 aOR = 1.92), respectively in the odds of shared sanitation cleanliness. Sanitation facilities shared by at most five households (95% CI: 6−7) were generally clean. High-quality shared toilets had live-in landlords, functional door locks, and were water-dependent. Further studies on innovative approaches to maintaining the quality of these high-quality shared toilets are needed to make them eligible for classification as basic sanitation considering the increasing reliance on the facilities.

Women 'holding it' in urban India: Toilet avoidance as an under-recognized health outcome of sanitation insecurity

Emerging research on sanitation challenges in the Global South increasingly uncovers health and social impacts by gender, particularly lack of sanitation safety. Women may employ strategies to avoid urination or defecation ('holding it') in the absence of safe sanitation, but the practice is not well understood. We quantitatively analyze survey data on women from urban slums across three cities in Maharashtra, India whose households constructed a toilet through an intervention programme. We assess relationships between household versus shared sanitation, perceptions of safety, and women's toilet avoidance behaviours, including diet restriction. At baseline, women have more than three times the odds of reporting avoidance behaviours if they perceive a community toilet to be unsafe, even after controlling for other factors. Household water insecurity is also instrumental in the relationship between avoidance and lack of safety. Finally, avoidance exhibits a significant and major drop upon provision of a household toilet. This study provides substantial support for the prevalence of habitual toilet avoidance among vulnerable urban women without access to safe sanitation. We conclude with recommendations for policy approaches and call for more attention to the health repercussions of habitual toilet avoidance among women as a consequence of sanitation insecurity.

Toilet Injuries Presenting to Emergency Departments, 2000-2019: A Different Game of Thrones

OBJECTIVE

Toilet training is a major developmental milestone. Unsupervised periods combined with immature gross and fine motor skills may lead to toddler injuries during toilet training. Our aim was to investigate toilet-related injuries (TIs) in children.

METHODS

Data from the National Electronic Injury Surveillance System were used to evaluate emergency department encounters of children ages 0 to 6 years with TI from 2000 to 2019.

RESULTS

There were an estimated 142,606 children (95% confidence interval, 115,599-168,613) who presented to the emergency department for TI. Toilets were involved in 95% of injuries, and other potty chairs (PCs) involved 5% of injuries. Children had higher odds of sustaining head injury while using a toilet versus PC (adjusted odds ratio = 1.91; 95% CI, 1.06-3.45).

CONCLUSIONS

Toilet-related injuries present a high burden of risk to young children. Our data support that the safest vessel for use in toilet training is a PC/training seat as opposed to the toilet.